health and illness, sociology of
The measurement of patterns of health and illness is far from easy, even when definitions have been agreed. Researchers employ two main sources when measuring ill-health—official statistics and community surveys. Official statistics provide data on persons who have had some contact with the health services—so-called ‘treated’ cases. This means that, whilst the data are more readily accessible, they are contaminated by illness behaviour; that is, by people's willingness to use health services, their access to services, their perception of their illness, and so forth. Community surveys circumvent this problem by screening general populations independently of health service contact. However, they usually rely on various self-report scales for measuring ill-health, and the relation between these measures and clinically defined sickness is problematic. Not surprisingly perhaps, mortality statistics are often used as a substitute measure of morbidity statistics on the grounds that in developed societies where many people die from degenerative conditions, the age at which an individual dies offers some measure of their life-time health. Given the limitations of these different measures it is necessary, where possible, to examine a range of data in analysing the social distribution of sickness.
There can be no doubt, whatever the difficulties of measurement, that there are major differences in patterns of health and illness between societies, over time, and within a particular society. Historically, there have been long-term reductions in mortality in industrial societies, and on average life-expectancies are considerably higher in developed than developing societies. Ill-health and mortality are also related to age and sex. The young and the old are more vulnerable to sickness and death, and in most societies women live longer than men, though by some indices women experience more ill-health. There are also major differences by social class and ethnicity within societies. For example, Inequalities in Health: The Black Report ( P. Townsend and and N. Davidson , 1982)
found that in Britain death-rates of those aged 15 to 60 were some two and a half times as high for a person in social class V than in class I, and there is no sign of these differences declining.
Explaining these patterns of health and illness, or the distribution of specific illnesses, is far from easy. It is fashionable among the public and the medical profession to focus on so-called ‘health-related behaviours’, especially alcohol consumption, smoking, diet, and exercise, and the importance of these behaviours is, on the whole, quite well supported. However, sociologists generally seek to move beyond these individual behaviours, and to understand health and illness in terms of the broader features of society. Whilst the focus on health-related behaviours directs our attention to cultural factors determining patterns of consumption, as well as to the material resources that enable or inhibit particular patterns of consumption, there has also been considerable attention given to the impact of the productive process on health and illness, not only via occurrences such as industrial and environmental pollution or accidents at work, but also via stress-related diseases.
Though the evidence is often open to different interpretations, what is very clear is that social factors play a major part in generating health and illness. For example, epidemiological studies support the idea that autonomy and control at work are important factors in the aetiology of heart disease, and some suggest that what has been called the ‘effort-reward imbalance’—a work situation involving high demands but with low career prospects, job security, and financial reward—may also be a significant contributory factor. Reductions in opportunities for career advancement and differences in control over work have been linked to a number of other adverse consequences for health. Some studies show that pension rights may be important in explaining mortality differentials among adult and retired men and women from different class backgrounds.
A good overview of the field is given in Margaret Stacey , Sociology of Health and Illness—A Textbook (1988)
. See also BLACK REPORT; SICK ROLE.
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